Flexible cystoscopy and Urodynamic testing.

I had a cystoscopy about 6 months ago to see if I was a candidate for a procedure to reduce BPH.  While not pleasant, the cystoscopy went pretty quickly with, as noted above, a local anesthetic.  My problem was that I developed an infection.  I have given one antibiotic dosage.  Should I have been given more?  I don't know.  But, the infection was the worse part of the last six months.  I had a BPH procedure a couple of weeks later after the infection was cleared up with another round of antibiotics.  Things have been pretty good since then.  I want to emphasize that most people might have been ok with just one antibiotic dose after the cystoscopy.  It was my bad fortune to get the infection.

Hi,

I just want to say 'Thank you' to everyone who has taken the time and trouble to reply to my post, it is very much appreciated.

As with all things medical, different people have different experiences of the same thing but, from what you all say, I should have nothing to worry about. I shall look at it from the point of view that it is all part of life's rich tapestry.

It is also reassuring to know I am not alone in experiencing a variation in flowrate and I would concur that it gets slower when having to get up in the middle of the night with some instances of taking several minutes to 'get going' and having to get up again only ten minutes later to 'finish the job'.

Again, thank you.

Hi Stephen, I've had both at the Lister Hospital, Stevenage, UK.  Both procedures were under local anaesthetic squirted into the urethra and I didn't feel any pain during either.  The flexible cystoscopy was performed by a junior doctor supervised by my urology consultant and posed no problems whatsoever.  It lasted about 10 minutes and, although the first pee afterwards stung a little, I was OK afterwards.  The urodynamics procedure was a different kettle of fish.  The procedure was performed by a nurse-practitioner assisted by a nurse and was uncomfortable.  Three catheters are used, two fine ones which are pressure sensors - one in the bladder and one in the rectum.  The third catheter is much larger and is connected to a computer-driven pump which fills your bladder with sterile water until you feel as if you will burst.  This catheter is then removed and you pee into a container.  The computer monitors the flow rate and pressures from the sensors and produces a graph which is used to determine if you have a blockage.  This took about an hour for me and unfortunately the following day I developed an e-coli infection which took four courses of Nitrofurantoin to clear up over the period of about six weeks.  The flexible cystoscopy took place October 3rd 2016, the urodynamics on June 15 2017.  I'm still waiting to be followed up by the hospital so after nearly a year I still don't know if I need surgery.  I hope your experience is better then mine.

When I was advised to have a Urodynamic test, my doctor quickly ran through the procedure process but the thing she really emphasized was that it can be an embarrassing experience. The next thing I did was scour the internet to get some information on other people’s experience with this procedure. While there were some testimonials out there, nothing very recent, so I thought I’d post my experience for other people’s benefit.

Prior to the test I was told to arrive with a full but not uncomfortable bladder. When I entered the room the first thing I noticed was a hospital chair with leg stirrups and a collection bowl at the bottom. The Registered Nurse that was administering the test told me to get undressed from the waist down and I could leave my socks and shoes on. I asked her about a gown, and she said I would not be wearing a gown. Afterwards I understood why. It was because a gown would be in the way of what she had to do.

Next, I was asked if I stood or sat to pee (stand of course) and told me to pee in the container at the bottom of the chair. This was to empty my bladder as much as I could, and she also measured the amount.

She told me to sit in the chair, scoot forward and place my legs in the stirrups. Throughout the procedure the nurse told me what she was going to do before she did it. While being embarrassed, it was all very clinical, and the embarrassment did go away. I knew she did this test all day, every day and I was just another patient she would forget about as soon as I walked out the door.

She said the next step was to catharize me with a regular catheter to fully empty any residual urine in my bladder. This she also collected and measured. She cleaned the area, catharized me and removed the catheter.

Next, she cleaned the sides of my legs, lower bottom cheeks and anus in preparation for some electrodes. She attached the electrode’s and then inserted a small bladder pressure sensor in my rectum. This was very small and hardly noticeable.

The next part proved to be difficult. She had to insert a VERY small catheter that would be used to fill my bladder and ultimately, I would pee with this catheter installed. She could not get it to enter my bladder! She removed and installed it 3 times with no luck. I think the catheter is so delicate that she could not get enough force to get through the sphincter muscle and enter the bladder.

So, she had to try a slightly different catheter. This one had a slight curve on the end, and I think the end was slightly more rigid. Two more tries with this catheter, again, no luck. She then called in a nurse practitioner to try. It took her two tries but she got it in.

In short, the rest went this way: There was a chart on the wall in which it showed someone driving and they had to pee. From realizing you need to go, to looking for a rest stop, to ultimately pulling to the side of the road.

The saline solution was slowly put in my bladder, and I had to say how it was feeling with a reference to the chart. Throughout this I had to cough and sometimes bear down for measurements. I only had 180ml before I told her I was busting and would be peeing at the side of the road by now. A few minutes later she allowed me to pee into the measuring container while having the catheter still in place. Ultimately, I had 350ml in me because they took so long in getting the small catheter in and I had still been producing urine the whole time. Like all procedures, after it was done, it took seconds to remove everything, and I was out the door.

Bottom line: after you get over the initial embarrassment it was not a big deal test. If I had to again, I wouldn’t hesitate. The only discomfort I had was urinating the next couple of days was painful. Probably from the attempts to get the catheter in.

Hi Steve

I recently had a urodynamic study. It was a much easier procedure than I expected. Not painful, if at times uncomfortable.

I am 70 years old with a 35/40g prostate. For the last few years, I have had all the symptoms of BPH, namely incomplete emptying, frequency, intermittency, urgency, weak steam, straining and nocturia 6 or more times a night. I was put on Tamsulosin which did not really give any relief. I looked into having a PAE procedure and after much research decided against it for two reasons. I was concerned about non target embolization, although uncommon, it is a risk and the procedure does not appear to have great outcomes; I have since learnt that it should not even be considered where the prostate is relatively small. I then researched Aquablation and was fortunate that the urologist felt a urodynamic study should be done first.

The reason the urologist requested the procedure was, given the high IPSS score and relatively small prostate, it would identify if there was any obstruction. The outcome from the study showed that I do not have an obstruction. What it did identify was that I have a non-compliant bladder and an over active bladder.

For the last 3 months I have been prescribed bladder medication. I still have incomplete emptying, intermittency, urgency, weak steam, straining and nocturia. However, my frequency day and night has reduced by about 50%. Getting up 3 to 4 times a night is much more manageable.